Epilepsy Often Unrecognized in Early Alzheimer’s

Many people with Alzheimer’s disease develop epilepsy, and those who have both conditions are more likely to develop serious memory loss and other cognitive symptoms at a younger age than those without epilepsy, a new study shows. Increased awareness of epilepsy and Alzheimer’s is important, the authors note, because seizure activity in the brain can have a harmful impact on patients and often goes undiagnosed.

For the study, researchers at the Memory and Aging Center at the University of California, San Francisco, studied 54 men and women with epilepsy and Alzheimer’s or mild cognitive impairment, a serious form of memory loss that can lead to Alzheimer’s. Those with epilepsy began, on average, to show serious memory and thinking problems five to seven years earlier than those without epilepsy, at age 64 versus age 70 or 71.

Seizure activity, triggered by electrical disturbances in the brain, typically begin early in the course of the disease, when memory and thinking problems first became evident. In some cases seizures were associated with limb shaking and obvious symptoms. But often symptoms were subtle, including “spells,” falling, staring into space or fumbling with clothes.

An estimated 10 to 22 percent of people with Alzheimer’s develop seizures. Those who develop seizures typically have more severe symptoms, and they progress more rapidly. After death, autopsy reveals that those with seizures have more widespread loss of brain cells.

While epilepsy does not cause Alzheimer’s, the two disorders may share common biological pathways, and better understanding of the relationship may lead to better care and treatment.

“Epileptic activity associated with Alzheimer’s disease deserves increased attention because it has a harmful impact on these patients, can easily go unrecognized and untreated and may reflect pathogenic processes that also contribute to other aspects of the illness,” the authors note. The findings were published in the journal JAMA Neurology, from the American Medical Association.

Epilepsy medications can be effective in controlling seizures. Of the common drugs used to treat epilepsy, treatment was more successful for those given lamotrigine (brand name Lamictal) or levetiracetam (Keppra) than for those who took phenytoin (Dilantin and other brands), the study authors note.

“Careful identification and treatment of epilepsy in such patients may improve their clinical course,” the authors concluded.